Mobility, Transfers, Falls, Body Mechanics, and Emergencies

Mobility starts with the care plan

Before transferring or ambulating a resident, check the care plan and current condition. A Kansas CNA must know whether the resident is independent, standby (contact-guard) assist, one-person assist, two-person assist, mechanical lift, or non-weight-bearing. Do not downgrade the help required because the unit is busy; if the plan says two-person assist, wait for the second helper. If the resident is weaker, dizzy, confused, short of breath, or in new pain, stop and report before moving.

Prepare the environment. Lock bed and wheelchair brakes, move footrests, set the bed at a safe low height, clear clutter, check footwear, ready the destination, and keep the call light available. Use a gait belt when indicated, applied snugly over clothing (not on bare skin) and never over breasts, an ostomy, tubes, wounds, or a recent surgical site. Before standing, let the resident dangle (sit on the edge of the bed with feet flat) for a minute or two so blood pressure adjusts and orthostatic hypotension does not cause a faint.

Body mechanics protect everyone

Body mechanics means using the body to reduce strain. Keep the feet shoulder-width apart for a wide base of support, bend the knees and hips (not the waist), tighten the core, keep the load close to your body, and face the direction of movement to avoid twisting the spine. Lift with the legs, not the back. Push, pull, roll, or slide when possible instead of lifting, and raise the bed to waist height for care, then lower it before leaving.

Ask for help or use a mechanical device when a task is too heavy or unsafe; pride is not a safety plan. Injuring yourself can also injure the resident if a poorly controlled move ends in a fall. When transferring, stand on the resident's weak side so the side most likely to buckle is supported.

Mobility devices have their own rules. With a cane, the resident holds it on the strong side and advances the cane and the weak leg together. With a walker, the resident moves the walker first, then steps into it, and never leans over the front of it. Range-of-motion (ROM) exercises keep joints flexible: the CNA performs passive ROM for residents who cannot move a joint themselves, moving each joint slowly and gently and stopping at the point of pain or resistance, never forcing a joint.

Falls and near falls

If a resident begins to fall, do not try to hold them upright by force, which can injure you both. Widen your stance, pull the resident close against your body, and ease them to the floor, protecting the head and bending your knees to lower them gently. Call for help. After a fall, keep the resident still and stay with them. Do not move the resident, return them to bed, or offer food or fluids until the nurse assesses them, unless there is immediate danger such as fire.

Report exactly what happened and what you observed: location, the position the resident was found in, anything the resident said, pain, bleeding, visible injury, mental status, and whether the fall was witnessed. Document per policy after the resident is safe and the nurse is notified.

Emergencies: first safe action

Emergency questions reward correct sequence. For fire, remember RACE: Rescue residents in immediate danger, Activate the alarm, Contain the fire by closing doors and windows, and Extinguish or evacuate if trained and directed. For an extinguisher, PASS means Pull the pin, Aim at the base of the fire, Squeeze the handle, and Sweep side to side. Follow the facility plan and never use elevators during a fire.

For a conscious choking adult who cannot speak, cough, or breathe, call for help and deliver the facility-approved response if trained: current guidance alternates 5 back blows with 5 abdominal thrusts until the object clears or the resident becomes unresponsive; if the resident can cough forcefully, encourage coughing and stay close. If a resident becomes unresponsive and pulseless, start CPR with chest compressions at 100-120 per minute if trained and call the code.

For a seizure, protect from injury, ease the resident to the floor if needed, move objects away, do not restrain the resident, do not put anything in the mouth, turn the head or body to the side to keep the airway clear, time the seizure, and report. For any unresponsive resident, call for help, check responsiveness and breathing, and follow facility emergency procedure.

Exam traps

Reject answers that transfer against the care plan, leave a resident unattended on a toilet, pull on a paralyzed arm, walk a dizzy resident, unlock brakes before the resident is seated, move a fallen resident before nurse assessment, restrain a seizing resident, put an object in a seizing resident's mouth, use an elevator during a fire, or investigate a gas or smoke smell alone. Safe CNAs stop unsafe care early, call for help, and report changes promptly.